Constantinou Maria, Tsai James Y, Safran Howard
Brown University Oncology Group, Providence, Rhode Island, USA.
Cancer Invest. 2003;21(6):887-96. doi: 10.1081/cnv-120025092.
Effective locoregional treatments are needed for adenocarcinomas of the esophagus, stomach, and pancreas. Paclitaxel has been investigated as a radiation sensitizer for upper gastrointestinal malignancies. In esophageal cancer, the combination of low-dose weekly paclitaxel, platinum, and concurrent radiation therapy (RT) has substantial activity and is well tolerated. Regimens that add fluorouracil (5-FU) to paclitaxel and platinum or incorporate hyperfractionation radiation have a higher incidence of severe esophagitis. In gastric cancer, adjuvant concurrent paclitaxel, 5-FU, and radiation is being investigated in the cooperative group setting. In pancreatic cancer, paclitaxel may be a radiation sensitizer even to tumor cells that are resistant to paclitaxel as a single agent. The Radiation Therapy Oncology Group (RTOG) demonstrated a 43% 1-year survival with paclitaxel/RT for patients with locally advanced pancreatic cancer. This represented a 40% improvement in survival compared to the previous RTOG 92-09 study of 5-FU-based chemoradiation. Ongoing trials in pancreatic cancer are investigating the addition of gemcitabine to paclitaxel and radiation and incorporating molecular targeting agents.
食管癌、胃癌和胰腺癌需要有效的局部区域治疗。紫杉醇已被研究作为上消化道恶性肿瘤的放射增敏剂。在食管癌中，低剂量每周一次的紫杉醇、铂类与同步放疗（RT）联合应用具有显著活性且耐受性良好。在紫杉醇和铂类方案中添加氟尿嘧啶（5-FU）或采用超分割放疗的方案，严重食管炎的发生率更高。在胃癌中，正在协作组环境中研究辅助性同步紫杉醇、5-FU和放疗。在胰腺癌中，紫杉醇甚至可能对作为单一药物耐药的肿瘤细胞具有放射增敏作用。放射治疗肿瘤学组（RTOG）显示，局部晚期胰腺癌患者接受紫杉醇/放疗的1年生存率为43%。与之前RTOG 92-09基于5-FU的放化疗研究相比，生存率提高了40%。正在进行的胰腺癌试验正在研究在紫杉醇和放疗中添加吉西他滨以及加入分子靶向药物。
